Please use this identifier to cite or link to this item:
Title: Designing, developing, evaluating, and implementing a smartphone-delivered, rule-based conversational agent (DISCOVER): development of a conceptual framework
Authors: Dhinagaran, Dhakshenya Ardhithy
Martinengo, Laura
Ho, Ringo Moon-Ho
Joty, Shafiq
Kowatsch, Tobias
Atun, Rifat
Car, Lorainne Tudor
Keywords: Science::Medicine
Engineering::Computer science and engineering
Issue Date: 2022
Source: Dhinagaran, D. A., Martinengo, L., Ho, R. M., Joty, S., Kowatsch, T., Atun, R. & Car, L. T. (2022). Designing, developing, evaluating, and implementing a smartphone-delivered, rule-based conversational agent (DISCOVER): development of a conceptual framework. JMIR MHealth and UHealth, 10(10), e38740-.
Project: RG36/20 
Journal: JMIR mHealth and uHealth 
Abstract: Background: Conversational agents (CAs), also known as chatbots, are computer programs that simulate human conversations by using predetermined rule-based responses or artificial intelligence algorithms. They are increasingly used in health care, particularly via smartphones. There is, at present, no conceptual framework guiding the development of smartphone-based, rule-based CAs in health care. To fill this gap, we propose structured and tailored guidance for their design, development, evaluation, and implementation. Objective: The aim of this study was to develop a conceptual framework for the design, evaluation, and implementation of smartphone-delivered, rule-based, goal-oriented, and text-based CAs for health care. Methods: We followed the approach by Jabareen, which was based on the grounded theory method, to develop this conceptual framework. We performed 2 literature reviews focusing on health care CAs and conceptual frameworks for the development of mobile health interventions. We identified, named, categorized, integrated, and synthesized the information retrieved from the literature reviews to develop the conceptual framework. We then applied this framework by developing a CA and testing it in a feasibility study. Results: The Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER) conceptual framework includes 8 iterative steps grouped into 3 stages, as follows: design, comprising defining the goal, creating an identity, assembling the team, and selecting the delivery interface; development, including developing the content and building the conversation flow; and the evaluation and implementation of the CA. They were complemented by 2 cross-cutting considerations-user-centered design and privacy and security-that were relevant at all stages. This conceptual framework was successfully applied in the development of a CA to support lifestyle changes and prevent type 2 diabetes. Conclusions: Drawing on published evidence, the DISCOVER conceptual framework provides a step-by-step guide for developing rule-based, smartphone-delivered CAs. Further evaluation of this framework in diverse health care areas and settings and for a variety of users is needed to demonstrate its validity. Future research should aim to explore the use of CAs to deliver health care interventions, including behavior change and potential privacy and safety concerns.
ISSN: 2291-5222
DOI: 10.2196/38740
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
School of Computer Science and Engineering 
School of Social Sciences 
Rights: © Dhakshenya Ardhithy Dhinagaran, Laura Martinengo, Moon-Ho Ringo Ho, Shafiq Joty, Tobias Kowatsch, Rifat Atun, Lorainne Tudor Car. Originally published in JMIR mHealth and uHealth (, 04.10.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles
SCSE Journal Articles
SSS Journal Articles

Files in This Item:
File Description SizeFormat 
PDF (1).pdf902.6 kBAdobe PDFThumbnail

Citations 20

Updated on Jun 5, 2024

Web of ScienceTM
Citations 50

Updated on Oct 27, 2023

Page view(s)

Updated on Jun 11, 2024

Download(s) 50

Updated on Jun 11, 2024

Google ScholarTM




Items in DR-NTU are protected by copyright, with all rights reserved, unless otherwise indicated.